Objective To disuss the clinic characteristics,the etiologies and the misdiagnosis cause of hyperthyroidism featuring in vomit mainly.Methods The clinic data of 35 hyperthyroids featuring in vomit mainly were reviewed and analyzed.Results The hyperthyroids in this group were middle-aged female mainly whose symptoms showd that they vomit frequently with abdominal distention,thin,inappetence,chest congestion,palpitation;tachycardia;hypohepatia and electrolyte disturbance.Furthermore,their thyroid gland function assay is in concordance with the hyperthyroidism diagnosis.Treatment for antihyperthyroidism can get remarkable effects.Conclusion The patient showing vomit of unknown origin may be taken into account as hyperthyroid.The key points to prevent misdiagnosis are to detect thyroid gland function in time and to improve the understanding for un-typical hyperthyroidism.

0.05),APACHEⅡ score,and mortality were higher than those in negative group(P

Objective To explore the advantages and disadvantages of helicopter emergency medical services of South China in the long-distance transport for critical patients.Methods A total of 30 patients who received helicopter emergency medical services by Guangdong Generral Hospital from August 2004 to December 2014 were selected as the observation group,and the other 30 patients with similar conditions who received ground emergency medical services were selected as the control group.To analyses the difference between the two groups in the disease,transport distance,transportation time,costs and compliction by χ2-test,t-test and nonparametric test according types of data.Results There were significantly difference between two groups in transport distances (km) [578.0 (313.0,707.5)vs.214.5 (101.5,313.5),P <0.05],set-up time (min) [95.7 (56.7,133.4)vs.10.7 (6.8,15.7),P <0.05],transportation time (min) [112.3 (64.3,152.4) vs.146.8 (67.8,217.5),P <0.05],costs (yuan/h) [14378.5 (9887.0,16348.5)vs.557.0 (356.5, 787.5),P <0.05]and the distance/total time value [2.8 (1.3,4.8)vs.1.4 (0.8,2.8),P <0.05]. There was no significantly difference in the incidence of complications between two groups (χ2 =0.058,P >0.05).Conclusions Helicopter emergency medical services could shorten the transportation time of critical patients on long distance transportation,and improve the efficiency of first-aid.However,there were many disadvantages that need to be improved in the helicopter emergency medical service of China.

Objective To investigate the recent decade (1999 to 2009) incidence of committed suicide and attempted suicide of the Jinuo nationality in Jinuo Mountain and study the clinical characteristics of it. Methods 10 610 subjects at 44 Jinuo villagers committees were investigated by the method of door-to-door inquiry under the help of clues and collected the data of larithmics and medical history. Results 32 committed suicide patients were found in total, and the average incidence rate per year in the recent decade was 30. 16/100 000. 5 attempted suicide patients were found and the average incidence rate per year in the recent decade was 4.71/100 000. Conclusion The Jinuo committed suicide incidence rate is higher than nationwide level. The attempted suicide incidence rate is lower than nationwide level.

Objective:To survey the status quo of community practice bases for general practice residency training in Sichuan province.Methods:The study was a cross-sectional survey. Online questionnaires were distributed via a WeChat group to 71 teaching managers of primary practice bases for general practice residency training in Sichuan Province in April 2023, and was completed anonymously. The questionnaire was designed according to the Standard for Residency Standardized Training Bases in General Practice (2022 Revision) (referred to as the Base Standard), the Content and Standard for Residency Standardized Training-Rules for General Practice Training (2022 Revision) (referred to as the Rules), and the relevant literature. The contents of the questionnaire included the basic information of the teaching managers and their institutions. Results:Seventy-one questionnaires were distributed. A total of 52 questionnaires were filled, and 51 valid ones were returned with an effective recovery rate of 71.8%. The participants were from 17 urban areas in Sichuan province, including 10(19.6%) base directors, 19(37.3%) teaching directors, and 22(43.1%) teaching secretaries. Among 51 participants, 49(96.1%) knew the rules; and 49(96.1%) had received teacher training. More than 70% of the bases had classrooms, meeting rooms or libraries, projectors, and reference books on general medicine; 50(98.0%) bases met the requirements for faculty number and quality set by the base standard; 49(96.1%) had teaching teams, 45(88.2%) bases had held upgrading causes for teaching faculty, 47(92.2%) set up incentive mechanisms for teaching faculty, and 39(76.5%) of the teaching managers thought that the teaching faculty in their institutions was qualified; and 26(51.0%) thought the leadership of the bases fulfilled the "main leadership responsibility system". All bases had set up resident management system; over 70% of the bases had completed the system for enrollment, assessment, lecturing, case discussion, and teaching clinics. The main problems in the teaching bases included unequal ability of teaching team, lack of guidance and cohesion, and imperfect organization structure, etc.; and the awareness and willingness of teaching faculty need to be enhanced, the quality and teaching ability of teaching faculty need to be improved, and more attention should be paid by institutions to the training bases.Conclusion:The vast majority of community practice bases for general practice residency training in Sichuan province comply with the Standards in terms of scale, basic conditions, faculty requirements, and teaching requirements, but there are still certain problems that need to be further improved.

Objective:To compare and analyze the efficacy and safety of intraoperative radiotherapy (IORT) combined with conventional therapy (surgery combined with radiochemotherapy) and conventional therapy alone for pancreatic cancer.Methods:Literature review was conducted from PubMed, Cochrane Library, Web of Science, Embase, Chongqing VIP, CNKI, Wanfang Data and China Biomedical Literature Service System (SinoMed). The literatures that met the inclusion criteria were screened and the data were extracted. Meta-analysis was carried out by RevMan 5.4 software.Results:A total of 11 studies consisting of 813 patients were included. According to the combined results, compared with conventional therapy, IORT combined with conventional therapy could improve the overall survival rate of pancreatic cancer ( HR=0.66, 95% CI=0.54-0.81, Z=4.03, P<0.001), and did not increase the treatment-related side effects ( OR=1.00, 95% CI=0.69-1.46, Z=0.01, P=0.99), but failed to bring benefit to the local control rate ( HR=0.56, 95% CI=0.31-1.01, Z=1.93, P=0.05). Conclusions:The overall survival rate in the IORT combined with conventional therapy group is significantly better than that in the conventional therapy group. No significant difference is found in the treatment-related adverse reactions between two groups. IORT combined with conventional therapy is worthy of clinical application.

Objective To explore clinical efficacy of new types of operation based on perihilar resection to cure hilar cholangiocarcinoma.Methods The retrospective descriptive study was conducted.The clinicopathological data of 4 patients with different Bismuth type of hilar cholangiocarcinoma who were admitted to the Beijing Tsinghua Chunggung Hospital from December 2014 to June 2016 were collected.After preoperative examinations and evaluations,single perihilar resection or combined with central liver segmentectomy were performed.Observation indicators included:(1) intraoperative situations;(2) postoperative pathological examinations;(3) postoperative situations;(4) follow-up.Patients were followed up using outpatient examination up to June 2017.Follow-up included abdominal pain,fever,routine blood test,tumor marker test and imaging examination which detected tumor recurrence and metastasis.Measurement data were represented as average (range).Results (1) Intraoperative situations:4 patients received successful operations,with an average operation time of 512 minutes (range,300-620 minutes).Portal vein was blocked continuously,with an average occlusion time of 70 minutes (range,57-80 minutes),an average volume of intraoperative blood loss was 537 mL (range,200-1 000 mL).Two patients received transfusion of 2 U plasma,4 U plasma + 4 U red blood cell (RBC),respectively.(2) Postoperative pathological examinations:results of postoperative pathological examinations in 4 patients showed that tumor size was respectively 1.5 cm× 1.2 cm× 1.1 cm,1.3 cm× 1.1 cm× 1.0 cm,2.0 cm× 1.7 cm× 1.5 cm and 2.0 cm×2.0 cm× 1.5 cm.Tumor differentiation:1 and 3 patients were respectively detected in moderate-differentiated cholangiocarcinoma and low-differentiated cholangiocarcinoma.Positive nerve plexus invasion was found in all 4 patients and 3 patients had regional lymph node metastasis.Four patients received R0 resection.TNM staging:T2aN1M0 and T2bN1M0 were found in 1 and 3 patients,respectively.(3) Postoperative situations:of 4 patients,1 complicated with biliary leakage was cured by conservative treatment and then discharged from hospital at 67 days;3 had good recovery and then discharged from hospital at day 21,14 and 14,respectively.Patients didn't receive postoperative adjuvant treatment,such as chemoradiotherapy.(4) Follow-up:4 patients were followed up for 12-31 months.During follow-up,4 patients were in good condition,and 1 with transient fever was relieved by conservative treatment.Levels of tumor marker in 4 patients were normal,results of enhanced CT scan showed no signs of tumor recurrence and intrahepatic bile duct dilatation.Conclusion After precisely evaluating the tumor extension among segmental bile duct,single perihilar resection or combined with central segmentectomy can effectively cure hilar cholangiocarcinoma.